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Continuing Healthcare

Directly employed social workers in new flexible discharge to assess model

We are employing social workers in a new, flexible discharge to assess model in Gloucestershire Royal Hospital.

Providing services in Gloucester since April 2014, our well-regarded team have already established a flexible model for nurse assessments. We employ experienced nurses who carry out assessments during evenings and weekends.

By working flexibly, the nurses ensure no time is lost and meet families at times they find most convenient. For example, between December 2014 and May 2015, our nurses completed 221 assessments for patients moving from hospital into a care home. They took an average of just 1.8 days from referral to assessment being completed (this can take up to ten days in some areas).

From January 2016, we will be extending the same flexible model to the social work assessment. We will co-ordinate the whole of the discharge to assess process, employing and managing the social workers and nurses to ensure assessments are co-ordinated without delays.

The team will be spot purchasing beds across Gloucestershire and commissioning physiotherapy and occupational therapy.

Discharge to assess is based on the principle that once a patient is fit for discharge from hospital, they move into a community based bed in order for further assessments to take place. The model is effective in reducing lengthy delays in acute beds and ensuring the patient receives the assessments and support they need in the community, before a decision about their long term care is made.

Susan Adams, CHS Healthcare Manager for the south of England, said: “We are really delighted to launch this model which enables us to manage all the different parts of the ‘jigsaw’ of the discharge to assess process.”

“Having this full oversight, by employing social workers ourselves, gives us control of the whole workflow. We can avoid the delays that have traditionally arisen when one part of the health and social care sector is waiting for another part of the sector to carry out an assessment. We have proven the flexible working model works for the nurse assessments. By working during evenings and weekends, valuable time is not lost and equally, it works for families – many people have daytime work commitments and want to see the nurse during evenings or weekends.”

 

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